Professional Documents
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The WHO STEPwise approach to chronic disease risk factor surveillance (STEPS)
World Health Organization
20 Avenue Appia, 1211 Geneva 27, Switzerland For further information: www.who.int/chp/steps
The Question-by-Question Guide presents the STEPS Instrument with a brief explanation for each of the questions. The purpose of the Question-by-Question Guide is to provide background information to the interviewers and supervisors as to what is intended by each question. Interviewers can use this information when participants request clarification about specific questions or they do not know the answer. Interviewers and supervisors should refrain from offering their own interpretations.
Purpose
The table below is a brief guide to each of the columns in the Q-by-Q Guide.
Description This question reference number is designed to help interviewers find their place if interrupted. The question text to be read to the participants followed by question instructions. This column lists the available response options which the interviewer will be circling or filling in the text boxes. The skip instructions are shown on the right hand side of the responses and should be carefully followed during interviews. The column is designed to match data from the Instrument into the data entry tool, data analysis syntax, data book, and fact sheet.
Response
Code
Site Tailoring Renumber the instrument sequentially once the content has been finalized Select sections to use. Add expanded and optional questions as desired. Add site specific responses for demographic responses (e.g. C6). Change skip question identifiers from code to question number. This should never be changed or removed. The code is used as a general identifier for the data entry and analysis.
Response
Code
I1
Insert Cluster, Centre or Village name as appropriate Interviewer ID Record interviewer's identification Date of completion of the instrument Record date when instrument actually completed
I2 I3 I4
3 4
mm year
dd
For further guidance on obtaining consent, see Part 4, Section 1, Page 4-1-11.
Participant Id Number
Response
1 2 1 2 3 4 If NO, END
Code
I5 I6
hrs
I7
mins
Write family surname (reassure the participant on the confidential nature of this information and that this is only needed for follow up). First Name Write first name of respondent.
I8
I9
I10
Record and file identification information (I5 to I10) separately from the completed questionnaire.
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Response
Male Female 1 2
Code C1 C2
12
If known, Go to
C4
dd
mm
Years
year
13
C3
14
Years
C4
15
C5
16
C6
17
C7
18
C8
19
C9
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Response
88 1 2 3 4 5 77 88
Code
Go to T1 Go to T1 Go to T1
20
Quintile (Q) 1 More than Q 1, Q 2 More than Q 2, Q 3 More than Q 3, Q 4 More than Q 4 Don't Know Refused
21
C11
Behavioural Measurements
Now I am going to ask you some questions about various health behaviours. This includes things like smoking, drinking alcohol, eating fruits and vegetables and physical activity. Let's start with tobacco.
Question
Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes? (USE SHOWCARD) Ask the participant to think of any tobacco products he/she is smoking currently. Do you currently smoke tobacco products daily? This question is only for current smokers of tobacco products. How old were you when you first started smoking daily? For current daily smokers only. Ask the participant to think of the time when he/she started to smoke any tobacco products daily. Do you remember how long ago it was? (RECORD ONLY 1, NOT ALL 3) Dont know 77 If the participant doesnt remember his/her age when started smoking, then record the time in years, months or weeks as appropriate. On average, how many of the following do you smoke each day? (RECORD FOR EACH TYPE)
Response
Yes No Yes No Age (years) 1 2 1 2 If No, go to T6 If No, go to T6
Code
22
T1
23
T2
24
T3
Dont know 77 In Years OR OR in Months in Weeks
If known, go to
T5a
If known, go to
T5a
25
If known, go to
T5a
If Other, go to T5other, else go to T9
Manufactured cigarettes Hand-rolled cigarettes Pipes full of tobacco Cigars, cheroots, cigarillos Other
26
Dont know 77 For current daily smokers only. Specify zero if no products were used in each category instead of leaving
WHO STEPwise approach to chronic disease risk factor surveillance- Instrument v2.1
categories blank. Then go to T9 . Daily smokers don't have to answer Other (please specify):
Go to T9
T5othe r
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Response
Yes No Age (years) Dont Know 77
Code T6
1 2
If No, go to T9
28
If Known, go to
T9
T7
In Years
If Known, go to
T9
29
Dont know 77 If the participant doesn't remember his/her age when they started smoking, then record the time in weeks, months or years as appropriate. Do you currently use any smokeless tobacco such as [snuff, chewing tobacco, betel]? (USE SHOWCARD) Ask the participant to think of any smokeless tobacco products the he/she is using currently. Do you currently use smokeless tobacco products daily? For current users of smokeless tobacco products only. On average, how many times a day do you use . (RECORD FOR EACH TYPE, USE SHOWCARD) Don't Know 77 For daily users of smokeless tobacco products only. Record for each type of smokeless tobacco products. Record zero if no products were used in each category instead of leaving categories blank. Then go to T13 . Daily users of smokeless tobacco don't have to answer the question on past use T12. In the past, did you ever use smokeless tobacco such as [snuff, chewing tobacco, or betel] daily? Ask the participant to think of the time when he/she may have been using smokeless tobacco products on a daily basis. During the past 7 days, on how many days did someone in your home smoke when you were present? Record the number of days. During the past 7 days, on how many days did someone smoke in closed areas in your workplace (in the
OR OR
If Known, go to
T9
30
No
If No, go to T12
T9
31
Yes No Snuff, by mouth Snuff, by nose Chewing tobacco Betel, quid Other
1 2 If No, go to T12
If Other, go to T11 other,
32
else go to T13
Other (specify)
T11othe r
Go to
T13
Yes
33
T12
No 2
34
T13
35
T14
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Question
Have you ever consumed an alcoholic drink such as beer, wine, spirits, fermented cider or [add other local examples] )? (USE SHOWCARD OR SHOW EXAMPLES) Think of any drinks that contain alcohol. Have you consumed an alcoholic drink within the past 12 months? Think of any drinks that contain alcohol. During the past 12 months, how frequently have you had at least one alcoholic drink? (READ RESPONSES, USE SHOWCARD) Think of the past year only. Have you consumed an alcoholic drink within the past 30 days? Circle the appropriate response. During the past 30 days, on how many occasions did you have at least one alcoholic drink? Think of the past 30 days only. Record the number of occasions. Note that there can be more than one occasion in which alcohol is consumed in a given day. During the past 30 days, when you drank alcohol, on average, how many standard alcoholic drinks did you have during one drinking occasion? (USE SHOWCARD) Help the respondent by averaging out the total number of drinks. During the past 30 days, what was the largest number of standard alcoholic drinks you had on a single occasion, counting all types of alcoholic drinks together? Think of the past 30 days only. During the past 30 days, how many times did you have for men: five or more for women: four or more standard alcoholic drinks in a single drinking occasion? Think of the past 30 days only. Be sure to read the correct number of times: 5 or more for MEN, 4 or more for WOMEN.
Response
Yes 1
Code
36
A1a
No Yes No Daily 5-6 days per week 1-4 days per week 1-3 days per month Less than once a month Yes No 2 1 2 1 2 3 4 5 1 2 If No, go to D1 If No, go to D1 If No, go to D1
37
A1b
38
A2
39
A3
40
A4
41
A5
42
A6
43
A7
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1 2 3 4
A8
45
Sunday
A9g
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CORE: Diet
The next questions ask about the fruits and vegetables that you usually eat. I have a nutrition card here that shows you some examples of local fruits and vegetables. Each picture represents the size of a serving. As you answer these questions please think of a typical week in the last year.
Question
In a typical week, on how many days do you eat fruit? (USE SHOWCARD) Think of any fruit on the show card. A typical week means a "normal" week when your diet is not affected by cultural, religious, or other events. Do not report an average over a period. How many servings of fruit do you eat on one of those days? (USE SHOWCARD) Think of one day the participant can recall easily. In a typical week, on how many days do you eat vegetables? (USE SHOWCARD) Think of any vegetable on the show card. A typical week means a "normal" week when your diet is not affected by cultural, religious, or other events. Do not report an average over a period. How many servings of vegetables do you eat on one of those days? (USE SHOWCARD) Think of one day the participant can recall easily.
Response
Code
46
If Zero days, go to D3
D1
47
D2
48
If Zero days, go to D5
D3
49
D4
EXPANDED: Diet
What type of oil or fat is most often used for meal preparation in your household? Vegetable oil Lard or suet Butter or ghee Margarine Other None in particular None used Dont know Other On average, how many meals per week do you eat that were not prepared at a home? By meal, I mean breakfast, lunch and dinner. Record the number of meals. 1 2 3 4 5 If Other, go to D5other 6 7 77
50
D5
D5othe
51
D6
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Question
Does your work involve vigorousintensity activity that causes large increases in breathing or heart rate like [carrying or lifting heavy loads, digging or construction work] for at least 10 minutes continuously? Activities are regarded as vigorous intensity if they cause a large increase in breathing and/or heart rate. [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do vigorous-intensity activities as part of your work? Typical week means a week when a person is doing vigorous intensity activities and not an average over a period. Valid responses range from 17. How much time do you spend doing vigorous-intensity activities at work on a typical day? Think of one day you can recall easily. Consider only those activities undertaken continuously for 10 minutes or more. Probe very high responses (over 4 hrs) to verify. Does your work involve moderateintensity activity, that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously? Activities are regarded as moderate intensity if they cause a small increase in breathing and/or heart rate.
Response
Yes 1
Code
52
P1
No 2 If No, go to P 4
53
Number of days
P2
54
Hours : minutes
P3 (a-b)
:
hrs mins
55
P4
Yes No 1 2 If No, go to P 7
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[INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do moderate-intensity activities as part of your work? Valid responses range from 1-7 How much time do you spend doing moderate-intensity activities at work on a typical day? Think of one day you can recall easily. Consider only those activities undertaken continuously for 10 minutes or more. Probe very high responses (over 4 hrs) to verify.
56
Number of days
P5
57
Hours : minutes
P6 (a-b)
:
hrs mins
Travel to and from places The next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, to place of worship. [insert other examples if needed]
The introductory statement to the following questions on transport-related physical activity is very important. It asks and helps the participant to now think about how they travel around getting from place-to-place. This statement should not be omitted.
58
Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? Circle the appropriate response. In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places? Valid responses range from 1-7 How much time do you spend walking or bicycling for travel on a typical day? Think of one day you can recall easily. Consider the total amount of time walking or bicycling for trips of 10 minutes or more. Probe very high responses (over 4 hrs) to verify.
Yes No
1 2 If No, go to P 10
P7
59
Number of days
P8
60
Hours : minutes
P9 (a-b)
:
hrs mins
Recreational activities The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure),[insert relevant terms].
This introductory statement directs the participant to think about recreational activities. This can also be called discretionary or leisure time. It includes sports and exercise but is not limited to participation competitions. Activities reported should be done regularly and not just occasionally. It is important to focus on only recreational activities and not to include any activities already mentioned. This statement should not be omitted.
Question
Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football, ] for at least 10 minutes continuously? Activities are regarded as vigorous intensity if they cause a large increase in breathing and/or heart rate. [INSERT EXAMPLES] (USE SHOWCARD) In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational (leisure) activities? Valid responses range from 1-7. How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day? Think of one day you can recall easily.
Response
Yes 1
Code
61
P10
No 2 If No, go to P 13
62 63
Number of days
P11
Hours : minutes
:
hrs mins
P12 (a-b)
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Yes
64
P13
No 2 If No, go to P16
65
Number of days
P14
66
Hours : minutes
P15 (a-b)
:
hrs mins
67
Hours : minutes
P16 (a-b)
:
hrs min s
Response
Yes No Yes No Yes No 1 2 1 2 1 2 If No, go to H6 If No, go to H6
Code H1
69
H2a
70
H2b
71
Advice or treatment to lose weight
Advice to start or do more exercise Have you ever seen a traditional healer for raised blood pressure or hypertension? Circle the appropriate response. Are you currently taking any herbal or traditional remedy for your raised blood pressure? Circle the appropriate response.
72
H4
73
H5
Response
Yes No Yes No Yes No 1 2 1 2 1 2 If No, go to M1 If No, go to M1
75 76
Are you currently receiving any of the following treatments/advice for diabetes prescribed by a doctor or other health worker? Circle the appropriate response for each of the following. Insulin Drugs (medication) that you have taken in the past two weeks Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2
77
Advice to start or do more exercise Have you ever seen a traditional healer for diabetes or raised blood sugar? Circle the appropriate response. Are you currently taking any herbal or traditional remedy for your diabetes? Circle the appropriate response.
78 79
Physical Measurements
For guidance on taking and completing physical measurements, see Part 3, Section 3.
Response
Code M1 M2a
M2b
M3
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in Kilograms (kg)
.
Yes No 1 If Yes, go to M 8 2
M4 M5
CORE: Waist
85 86
Device ID for waist Record device ID. Waist circumference Record participant's waist circumference in centimetres. Interviewer ID Record interviewer's ID (in most cases technician would be the same as for height, weight and waist circumference). Device ID for blood pressure Record device ID. Cuff size used Circle size used Reading 1 Record first measurement after the participant has rested for 15 minutes. Wait 3 minutes before taking second measurement. Reading 2 Record second measurement. Ask the participant to rest for another 3 minutes before taking the third measurement. Reading 3 Record third measurement. During the past two weeks, have you been treated for raised blood pressure with drugs (medication) prescribed by a doctor or other health worker? Circle appropriate response. Small Medium Large Systolic ( mmHg) Diastolic (mmHg) Systolic ( mmHg) Diastolic (mmHg) Systolic ( mmHg) Diastolic (mmHg) Yes No
in Centimetres (cm)
M6 M7
M8
1 2 3
88 89
1 2
90
91
92
93
M15
95
Biochemical Measurements
For guidance on taking and completing physical measurements, see Part 3, Section 4.
Response
Yes No 1 2
During the past 12 hours have you had anything to eat or drink, other than water?
Code B1
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97 98 99 10 0 10 1
Technician ID Device ID Time of day blood specimen taken (24 hour clock) Fasting blood glucose Double check that the participant has fasted. Today, have you taken insulin or other drugs (medication) that have been prescribed by a doctor or other health worker for raised blood glucose?
Hours : minutes
B2 B3 B4 B5
:
hrs
mins
mmol/l Yes No
.
1 2
B6
.
1 2
B7 B8 B9
. .
B10 B11
Physical Measurements
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